Provider Demographics
NPI:1760465603
Name:HERMAN, GREGORY EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:EDWARD
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 DELSEA DR N
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1444
Mailing Address - Country:US
Mailing Address - Phone:856-853-2055
Mailing Address - Fax:856-686-5218
Practice Address - Street 1:75 W RED BANK AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1694
Practice Address - Country:US
Practice Address - Phone:856-853-2055
Practice Address - Fax:856-686-5218
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7872208Medicaid
NJ7872208Medicaid
NJ012752AWFMedicare PIN